Behind Closed Doors: A Nursing Memoir

May 2020

(Short listed for the Yeovil Literary Writing Without Restrictions Prize 2021)

My colleagues and I hadn’t taken it seriously, we were almost a little cocky, ‘Yeah. Yeah, we’ve seen H1N1, we’ve seen SARS, we’ve nursed in pandemics before’ So we carried on, until very quickly our office became an incident command center, execs in suits came through with sullen faces, our seniors started staying on site. Our paperwork changed, we now needed to log any Covid 19 patient, both queries and confirmed. The trust set up a POD outside the Emergency Department, we got huge deliveries of PPE. Staff had to fill in skill sheets – have you ever worked in ITU/ED? Have you ever looked after a ventilated patient? The world had suddenly changed.

              The day Boris Johnson announced the biggest change to the world and culture as we knew it, we sat together, the children and I, one little body tucked under each arm. A wool blanket draped over our knees, sunk deep into the sofa. We listened as we were told to stay at home, only key workers were allowed to go out to work, key worker children would get emergency school places. If we listened, if we stayed at home, we would be doing our bit to flatten the curve of Covid 19. Our bit to save lives. Of course, the children didn’t understand the enormity of it. They only heard ‘the schools are closed’. Both were delighted.

 ‘A long summer holiday Mummy’ my daughter said. I didn’t have the heart or the energy to explain. Once the children were in bed, I filled the dishwasher and cried.

****

On this day alone we have had over 1000 deaths reported in the UK. I struggle to equate that the patients I have cared for over the past few days have now become nothing more than a statistic, a number announced in the press. I have collected the data, the death forms that the nurses must complete for Covid deceased. The form doesn’t have their name, a name, irrelevant for data collection purposes, just their hospital number. Already condemned to be a government statistic, the by-line in tomorrow’s newspaper.

As a nurse, death has always been part of my daily work, as a site manager I see death all over the hospital. I support the staff, I tally the beds, after a death, I let the relatives know in the middle of the night, often comforting them with a cuddle, a cup of tea. But nothing on this scale. Even though we are early on in the expected surge of the illness, already death seems to be all around the hospital. I look through the doors of one of the Covid cohort wards, I watch as the patients lie, some with monitors attached, others with bare bedside tables. 02 masks in situ, lights from monitors flashing. If they call out I won’t be able to hear them. A nurse or health care assistant is close to the door to watch for untoward movements, worrying vital signs or death. I watch as a bay of 6 elderly ladies lie in waiting. They are alone, the nurse going in often, but in full PPE, her eyes only just visible behind her mask. The humanity and dignity which we as nurses fight for in death seems to be lost here. We cannot give these people the death they (we all) so deserve. Covid seems to make a mockery of life – picking at random who will and won’t survive. All I can do is watch from behind the closed door.

Yet of course I’m not always watching. As I arrive to start my shift my colleagues are running out of the office.

‘Cardiac arrest ward 6b, see you there’ Off they run. I change quickly, then hurriedly make my way to join them. It’s 09:50, my shift doesn’t officially start until 10am. I arrive to the team in full PPE behind a closed bay door. Luckily the patient is the only patient in the bay. So door closed, enough staff in there to reduce the risk to us all, we stand outside running for equipment. After 45 minutes of down time, of no cardiac output/activity, the team stop. A solemn, surreal moment passes now as the team who tried so hard to resuscitate him must stay in the room for 20 minutes to allow the covid partials to drop. Standing together in their grief, their frustration, reflection, with the now dead body. 20 minutes, it’s a long time. The patient was 35, he had underlying health conditions, but does that actually really matter? Here we lost a Dad, a Son, someone’s husband, someone’s friend. For some of us, he was our first Covid death.

We are soon bleeped to another emergency. A 44 year old lady. She is alert and awake on my arrival, I am now in my full PPE. She cannot see my face, my eyes or my smile. I’m with her for an hour, giving her fluids, attempting to catheterise her. I think she is becoming more stable, her blood pressure has risen from 70 to 100. I’m so hot in the PPE, I’m worried I might pass out. I haven’t had a drink for about 4 hours. Little beads of sweat rest upon my forehead, I have no means of wiping them away. My patient suddenly becomes wild. A rabid beast. She lifts herself from the bed, I try to get her to lie back down, but an almighty strength possesses her. She pushes me to the ground, I call for help, I try to calm her. Instead she falls in my arms. I notice she has wet the bed, she looks me in my eyes, a terrified plea for me to help her. And then her eyes glaze over, become empty. Still. She has arrested, heavy and cumbersome. Still in my arms, we lower her to the floor, I start chest compressions. For the next 3 hours we resuscitate her in a closed side-room, the door unable to be opened frequently so as to keep the Covid within. Her heartbeat intermediately returns, but then stops again numerous times. A roller coaster of emotion for us trying to save her. The final time she loses output, her heart stops. We try and try to save her, but she’s gone. She was 44 years old.

As I leave the sideroom I see through the loosely pulled curtains the bed opposite. There sits a young woman, her hair gone from the chemo she has had. She watches me leave. I smile, apologetically, she knows what has happened behind the closed door. She knows the woman is now dead. My smile is lost behind my mask. She, who was told she had a good prognosis from her cancer is now too fighting Covid, and watching those around her fall. I wish I could reassure her, I wish she could see my smile. I wish she hadn’t had to witness what she just had. I want to tell her I’m sorry.

My scrubs are stuck to me, my underwear under them sodden. I shower in the critical care unit. It’s almost 4pm. I’ve not had my morning coffee yet. After my shower, I put on my still damp underwear, my bra pungent with sweat, but at least I have fresh scrubs. From this day on, I carry a change of underwear in my bag.

I’m no longer watching from behind a closed door, I’m now behind it with these patients. 

****

Later that week a man died in a bay of 6 beds. Five other men lay in close proximity, hearing his breathing, fast and difficult, his spluttering coughs fade into nothing, a stillness. The curtains closed around him. The monitors subtly turned off earlier by a figure in full PPE. These patients would never see this figure’s face. My team was called because 3 of the man’s sons, told of their father’s death, were en-route to the hospital. Grief stricken and angry, they wanted to see him, hold his hand, say goodbye.

How cruel and unnatural to deny them entry into the hospital. I explained that they couldn’t see their dad. He had died in a bay with other positive patients, on a ward where no one could enter without full PPE. We could not put them at risk by allowing them in. They cried, they shouted, they accused me of being inhuman, of having no heart. I agreed with all they said, for I had become a monster. Who would deny a son the chance to kiss the forehead of his deceased father? In time they understood, they too would be put at great risk, they understood it wasn’t my fault. I too wanted them to see their father. In normal non-Covid times I would have hugged them, taken them by the hand and led them to him. The government was clear – NO VISITORS even in death.

                                                                               ****              

My son woke up with a temperature, a dry cough. I now have to self isolate for 14 days. I feel incredibly guilty about not being on my shift, about letting my colleagues and my patients down. Yet this is such a bittersweet situation, as I also feel a sense of relief. This is a totally new feeling for me, I love my job, I always have. But I’m tired and I know we are not even in the thick of it yet. I’m also scared. I’m really scared. I’m scared I’ll get ill and end up in ITU, which is actually the lesser of 2 evils. What if I die? What if I catch this evil virus and it kills me? We have been too complacent with only thinking it kills the elderly or those who have got pre-existing health conditions – it can and IS killing anyone. For the first time in my life my mortality has become fragile. The thought of leaving my children is one I cannot bear. In my head I have practised little videos, the ‘only watch this when’ type. And I will make a collection of them, but not just yet. I can’t bring myself to do this just yet. Having a few weeks off, I hope will allow me to recharge and regain my strength and emotional stability. Never in my almost 20-year career have I felt this vulnerable, this fragile or this afraid.

I took my son for a evening solitary walk, we watched the night fall and rest on the lake. The tree tops still alight from the moon and the trains occasionally running alongside the edge of the park. On the way home we discovered a cat was following us. The cat appeared from nowhere at our feet and continued with us until arriving at our door, then very comfortably, walked into our house. The cat asleep at the side of my bed after a plate of milk and a donation of cat food and a litter tray from a neighbour. It doesn’t seem well, is very lethargic and seems to only sleep. I pray he hasn’t come here to die, I fear this will be too much for me to take.  Please let him see the morning. Overnight the cat seems completely still, he remains in the same position on my old sofa blanket curled on our bedroom floor. The few times I wake I strain my eyes to look at him. I fear the worst but I am too fatigued to get out of bed and have my worst fears confirmed.

The morning arrives with a blast of light from the corner of the window not covered by the curtains. The cat has survived. It must have gotten up in the middle of night, as half the bowl of cat food was eaten. I’d placed a picture of him on our local community forum. Later I receive a phone call from a neighbour. Shortly after ‘Ronnie’ the cat was retrieved and taken back to his rightful home. We were all a bit sad, as it was quite nice to have a pet and of course something different to focus on. Maybe when this is all over, we’ll get a pet? When will all this be over?

My son’s cough has continued, with my daughter developing one shortly after. Is this a usual, viral cough or something more sinister? I keep my (clean) stethoscope close by. Soon my throat begins to ache, and I develop horrible body pains. Although a cliché, I really do feel like I’ve been hit by a bus. Getting up and down the stairs is painful, I’m getting short of breath if I exert myself too much. Although I have no cough.

              A few nights later I feel utterly exhausted. I have a bath with my daughter, I read her Harry Potter, but I am too tired and the words are slurring. I’m like an old drunk. She soon gets bored and goes downstairs. I wake up in the cold bath. I am shivering. I feel awful, I am now lying in freezing water, shivering with a heavy body and it is dark outside. I struggle to climb out. I discover I’ve been asleep in the bath for over an hour.

              Later as I lay in bed, my chest feels tight. I believe I’m going to die in my sleep. It sounds terribly dramatic. My news feed has been full of headlines about young people dying at home alone, or being found dead after mild symptoms. Why should I be different?  Rationally, why should I be different from the thousands who have mild symptoms? But I don’t see them. I only see the worst. If my oxygen levels were to drop overnight, who would notice? Who would decide if I needed intubation? I think of the 26 year old man I assessed during my last night shift. His oxygen levels had been teetering at worrying levels. If they dropped, I would have to increase his oxygen to 15L via a non-rebreathe mask. (This is the most 02 you can deliver through a facemask). If this were to happen, he would need to be intubated and put on a ventilator. Luckily with close monitoring from myself and his nursing staff he survived the night without needing intubation. I wonder how he is now? I hope that night was the peak of his illness and he has now started to recover.

              The next morning, I ordered a portable saturations probe from Amazon – it won’t be delivered for 5 weeks. But still it has given me some comfort.

***

We have all recovered, I was unable to get a covid test. I’m a senior nurse, a clinical hospital site manager attending medical emergencies and visiting covid positive patients. Yet I was unable to get a test. Did we have covid? Or had we all suffered another form of viral illness?

Back at work the mood has shifted, the hospital has a new landscape. Dental nurses work in ITU, helping with intubated patients’ mouth care. Teams have been set up to roll and turn the intubated patients. My own team now wear individual back packs containing full PPE for when we get called to an emergency. As I do my rounds (visiting each ward to check on staff/patients) the faces of the staff have changed. There seems to be an air of determination, a focus, the initial fear seems to have subsided. Staff can quickly and now expertly get into full PPE, can take turns going into the ‘hot zones’, limiting the exposure to themselves but still ensuring their patients are cared for.

I visit a care-of-the-elderly ward, one of our only ‘cold’ wards. So the patients here have had negative Covid swabs and are displaying no symptoms, yet staff still wear facemasks, eye guards, gloves and aprons. We, of course, don’t want to pass any germs onto the patients, we’re still not being tested. A nurse is crying, she is young, early 20’s. When she sees me she tries to compose herself. I approach, grab her gloved hand in my own. I take her away from the nursing station, away from the watching eyes of other staff. Here she tells me an elderly woman with dementia keeps shouting at her, the lady has been shouting at all the nurses during the shift making a few of them cry. Initially I am a little impatient, an elderly demented patient shouting, surely the staff here are used to this kind of behaviour? But soon I realise that now, at this current time, this level of abuse (although not intentional, the lady is confused and probably scared by staff wearing masks and goggles) is the tipping point. The nurse tells me that the patient said to her ‘Your children will die’. The nurse started crying again. After my reassurances that the lady is confused and didn’t mean it, the nurse informed she has a 10 month old baby. Her mother-in-law and husband had decided that while she was working in the hospital the baby should stay with her mother-in-law. They didn’t want to put the baby at risk. She had thought of handing in her notice, but she has a mortgage to pay. She hasn’t seen her son for 5 weeks, and didn’t know when she would again. Before and after each shift she expressed milk to throw away. She didn’t want to keep it in case it was infected. Equally she didn’t want to stop breast-feeding and hoped to resume once the pandemic is over and she’s reunited with her child and husband. I hugged her, me in a mask, visor, apron and gloves, her too.

Later when I got home, before hugging my own family, I took off my commuting clothes, placed them in the washing machine with a pillow case full of my day’s uniform. I showered, washed my hair, scrubbed my body a number of times. Only then was I ready to hug the children. This was a ritual we had all got used too. As they kissed me and tucked me up in bed (after my nightshift), another ritual, I thought of the nurse, going home to an empty house, the empty cot where her baby should be, toys in his bedroom, his clothes hanging in his wardrobe. I imagined her sat on the chair where she normally feeds him. This morning instead of holding him, it would be a pump.  Her frantically trying to keep her milk supply up for the day her baby and normality returns.

***

              Commuting into work has become an eerie walk through the twilight zone, empty streets, shut up shops, minimal litter. As I get off a train at London Victoria only one other person emerges from the carriages. Skeleton staff in small clusters are the only other people in the station. The cafes, magazine shops, coffee carts, all shut, like before the last train on Christmas Eve, but without the roar of excitement and crowds.

              Leaving the station, my descent into an alternative universe continues. The streets seem so wide, so big. Only a few empty buses drive past. The traffic lights are red but I can still cross as the roads are deserted. Then I hear some shouting, swearing. A gang of homeless people stand on the steps of a locked-up theatre, no less than 15. None socially distancing. The tension is palpable, their voices are getting louder, a woman is spitting out swear words at a man sat on the steps. I cross the road so as not to walk directly past them. As I do a scuffle breaks out. I walk quickly. I don’t want to look behind. I later mention this in the office, my colleague reminds me these are desperate times. Currently the homeless can’t get money from begging to commuters, but even with funds no shops are open. Drugs and alcohol are also limited, again the usual lines of supply shut down. But also, water, drinks. If you’re currently homeless in central London, you’re likely to be thirsty. Toilets, water fountains have all been shut, these people have no access to water or food. Imagine feeling constantly thirsty, here, now in the western world?

***

              Boris Johnson was admitted to hospital yesterday. I’d predicted this after watching him stand outside number 10 clapping for the NHS of Thursday. (Oh the irony.) He looked awful. He was flushed and slightly short of breath. I told my husband that I wouldn’t be surprised if he was in ITU by the end of the week. And here he is, admitted to ITU. The press report he is not intubated (yet).

              As during most nights, I’m finding it difficult to sleep. Last night I stayed up watching The Crown. Interestingly, it was the episode where JF Kennedy gets shot. The Queen ordered the bells of Westminster Abbey to ring out for a whole hour, normally only done if a member of the royal family dies. Would they do this for Boris? I had this strange sense all night that the news would come through that he had died. It didn’t, yet this sense of gloom and his demise filled my thoughts. He’ll be lucky to get through this, statistically he fits the group that may not. (Slightly overweight, no doubt has some decree of hypertension and high cholesterol). Time will tell us, like many families and friends all over the world waiting for news of their own loved ones, unable to see or speak to them.

              And then I received news that my friend Ben had passed away. 5am yesterday, he went into cardiac arrest after a week’s stay in ITU. He was 43. His underlying medical condition – overweight and high blood pressure.

              I haven’t seen Ben for a number of years, but his brother and I have been close friends since childhood. Both families lived a street apart, so he’d always been there, as long as I can remember. I crumbled at the news, totally crumbled. His brother described to me how in ITU they had decided to turn him to the prone position. As they were turning him, he arrested. I can see this scene so clearly. I can see the team running around him, doing compressions, administering adrenaline. I wish I couldn’t see these things; I wish I could see him die in peace and with dignity. Unfortunately, there is no dignity in cardiac arrest, broken ribs, bleeding orifices. Amazing for those it saves, but horrendous and brutal for those it doesn’t. I wish I couldn’t see these things.

              I wanted to grieve, I wanted time to reminisce, time to process that he was dead. But of course, this doesn’t happen when you have two children. My children struggle when I’m not on form, I’m their constant, always in control always ok. Today I’m not, therefore they are not. My daughter screamed and kicked at me, telling me how much she hates me, that it’s my fault she can’t see her friends, that she’s going to run off, find a new Mummy. I know this is all her immaturity, her own fear at seeing Mummy cry, hearing that Mummy’s friend has died, she can’t process this. Most adults can’t process death, why should a scared seven-year-old girl be able to? And I shouldn’t have expected her to. She was vile all day, her behaviour only made my grief worse, intolerable. I wanted to be alone with my thoughts. Being alone with thoughts is not something that happens easily during a lockdown/pandemic.

              Later that night, the children asleep, my husband catching up with work. I lock the bathroom door. Behind the closed door I lie in the bath and I cry and I cry.